1437327863 NPI number — GMJS PHARMACY INC

Table of content: (NPI 1437327863)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437327863 NPI number — GMJS PHARMACY INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GMJS PHARMACY INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1437327863
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/25/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4320 43RD AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SUNNYSIDE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11104-2212
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-937-0890
Provider Business Mailing Address Fax Number:
718-784-2438

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4320 43RD AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SUNNYSIDE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11104-2212
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-937-0890
Provider Business Practice Location Address Fax Number:
718-784-2438
Provider Enumeration Date:
02/19/2008

Additional Information

Authorized Official

Authorized Official Last Name:
HIDALGO
Authorized Official First Name:
MARTHA
Authorized Official Middle Name:
Authorized Official Title or Position:
SECRETARY
Authorized Official Telephone Number:
718-233-3486

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  028728 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2959231 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3357438 . This is a "NCPDP PROVIDER IDENTIFICATION NUMBER" identifier . This identifiers is of the category "OTHER".




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